AHA Coding Clinic® for ICD-9 - 2012 Issue 1; Clarification
Borderline Diagnoses
Coders are confused as to the correct coding of “borderline” diagnosis. The advice published in Coding Clinic, First Quarter 2011, pages 9-10, appears to be contradictory. The advice instructs coders to assign code 416.8, Other chronic pulmonary heart diseases, for borderline pulmonary hypertension as if it were confirmed; however, a diagnosis of borderline diabetes without further confirmation of the disease is assigned to code 790.20, Abnormal glucose. Should code 793.2, Nonspecific (Abnormal) findings on radiological and other examination of body structure, Other intrathoracic organ, be assigned for a diagnosis of “borderline pulmonary hypertension” or should all borderline diagnoses require clarification from the attending physician so that the appropriate code may be reported? ...
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Article Overview
This article examines coding guidance related to borderline diagnoses, with attention to the way published advice has been interpreted for different clinical situations. It is intended for coders and coding staff who need to understand the scope of the issue, the relevant code sets involved, and the general question of when additional clarification may be necessary.
Why This Topic Matters
Borderline diagnosis terminology can create uncertainty in code selection and documentation review. Understanding the applicable guidance helps coders recognize when a diagnosis may be treated differently depending on the clinical context and published coding advice.
What You Will Learn
- How borderline diagnoses are discussed in coding guidance
- Why similar terminology may lead to different coding considerations
- What kinds of documentation questions arise when diagnosis wording is uncertain
- How published coding advice can affect interpretation of borderline conditions
Who Should Read This
- Medical coders
- Coding auditors
- Health information management professionals
- Clinical documentation staff
Codes Discussed
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